CPT code 46600: Diagnostic anoscopy, standard visualization, optional washing2026 Medicare rate & RVUs in Madera, CA
A clinician examines the anal canal with an anoscope for diagnostic purposes, optionally collecting cells or secretions by brushing or washing.
In Madera, CA, Medicare pays $138.38 for 46600 in the office and $41.37 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 46600 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 46600 covers
A clinician inserts a short anoscope to inspect the anal canal and nearby distal rectum. Colorectal surgeons, gastroenterologists, and other clinicians may perform the exam in an office or outpatient setting to evaluate symptoms such as anal pain or bleeding, or findings such as suspected hemorrhoids, fissures, or an anal canal lesion. Collection of a specimen by brushing or washing can be part of this diagnostic service.
Report 46600 when the anoscopy is diagnostic and does not include a separately defined service such as biopsy, dilation, or lesion removal. Document the indication, examination findings, and any brushing or washing performed. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral adjustment is inappropriate; assistant-at-surgery payment is restricted, and co-surgeon and team-surgery payment are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
How Madera, CA compares for 46600
Across 109 of 109 payment localities, the office rate for 46600 runs from $112.37 in Arkansas to $177.50 in San Benito County, CA. Madera, CA pays $138.38. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Madera, CA · this page$138.38
- Bakersfield, CA · California$138.61+$0.23
- Chico, CA · California$138.38
- El Centro, CA · California$138.40+$0.02
- Fresno, CA · California$138.38
- Hanford, CA · California$138.38
- Los Angeles, CA · California$148.57+$10.19
Other areas in California first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| Merced, CACalifornia | $138.38 | $41.37 |
| Modesto, CACalifornia | $138.38 | $41.37 |
| Napa, CACalifornia | $163.16 | $46.50 |
| Oxnard, CACalifornia | $148.12 | $43.50 |
| Redding, CACalifornia | $138.38 | $41.37 |
| Rest of CaliforniaCalifornia | $138.38 | $41.37 |
| Riverside, CACalifornia | $139.25 | $42.24 |
| Sacramento, CACalifornia | $145.98 | $43.04 |
| Salinas, CACalifornia | $145.45 | $42.87 |
| San Diego, CACalifornia | $149.46 | $43.59 |
| Marin County, CACalifornia | $173.57 | $48.76 |
| San Francisco, CACalifornia | $173.47 | $48.67 |
| San Benito County, CACalifornia | $177.50 | $49.87 |
| Santa Clara County, CACalifornia | $177.13 | $49.50 |
| San Luis Obispo, CACalifornia | $143.04 | $42.22 |
| Santa Cruz, CACalifornia | $151.33 | $43.79 |
| Santa Maria, CACalifornia | $146.16 | $42.95 |
| Santa Rosa, CACalifornia | $152.90 | $44.21 |
| Stockton, CACalifornia | $138.38 | $41.37 |
| Vallejo, CACalifornia | $163.03 | $46.37 |
| Visalia, CACalifornia | $138.38 | $41.37 |
| Yuba City, CACalifornia | $138.38 | $41.37 |
| Washington, DC areaDistrict of Columbia | $149.47 | $45.20 |
| Miami, FLFlorida | $137.45 | $45.31 |
| Chicago, ILIllinois | $133.06 | $44.10 |
| Manhattan, NYNew York | $149.18 | $46.33 |
| AlaskaAlaska | $143.78 | $49.51 |
| AlabamaAlabama | $114.24 | $36.79 |
| ArkansasArkansas | $112.37 | $36.34 |
| ArizonaArizona | $125.19 | $39.42 |
| ColoradoColorado | $135.48 | $41.31 |
| ConnecticutConnecticut | $138.18 | $42.85 |
| DelawareDelaware | $127.45 | $40.00 |
| Fort Lauderdale, FLFlorida | $132.49 | $42.83 |
| Rest of FloridaFlorida | $125.51 | $40.89 |
| Atlanta, GAGeorgia | $131.25 | $41.32 |
| Rest of GeorgiaGeorgia | $117.75 | $38.80 |
| Hawaii, Guam, HIHawaii | $142.63 | $41.99 |
| IowaIowa | $118.12 | $37.13 |
| IdahoIdaho | $118.86 | $37.43 |
| East St. Louis, ILIllinois | $122.98 | $41.55 |
| Rest of IllinoisIllinois | $121.02 | $40.20 |
| Suburban Chicago, ILIllinois | $134.04 | $43.14 |
| IndianaIndiana | $119.65 | $37.60 |
| KansasKansas | $117.21 | $37.20 |
| KentuckyKentucky | $116.69 | $38.00 |
| New Orleans, LALouisiana | $122.91 | $39.62 |
| Rest of LouisianaLouisiana | $116.37 | $38.04 |
| Metropolitan Boston, MAMassachusetts | $150.37 | $44.68 |
| Rest of MassachusettsMassachusetts | $134.41 | $41.21 |
| Baltimore area, MDMaryland | $137.75 | $42.78 |
| Rest of MarylandMaryland | $130.19 | $40.61 |
| Rest of MaineMaine | $119.26 | $37.83 |
| Southern Maine, MEMaine | $126.97 | $39.25 |
| Detroit, MIMichigan | $126.97 | $41.56 |
| Rest of MichiganMichigan | $119.86 | $39.05 |
| MinnesotaMinnesota | $130.18 | $39.11 |
| Metropolitan Kansas City, MOMissouri | $122.26 | $39.15 |
| Metropolitan St. Louis, MOMissouri | $123.74 | $39.47 |
| Rest of MissouriMissouri | $113.92 | $37.63 |
| MississippiMississippi | $113.19 | $36.98 |
| MontanaMontana | $128.92 | $40.41 |
| North CarolinaNorth Carolina | $120.71 | $38.13 |
| North DakotaNorth Dakota | $127.34 | $38.83 |
| NebraskaNebraska | $118.93 | $37.24 |
| New HampshireNew Hampshire | $133.03 | $40.89 |
| Northern New JerseyNew Jersey | $147.56 | $44.89 |
| Rest of New JerseyNew Jersey | $139.86 | $43.21 |
| New MexicoNew Mexico | $120.48 | $39.32 |
| NevadaNevada | $128.59 | $39.99 |
| NYC suburbs and Long Island, NYNew York | $152.83 | $47.58 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $140.58 | $43.66 |
| Queens, NYNew York | $150.96 | $46.34 |
| Rest of New YorkNew York | $122.72 | $38.64 |
| OhioOhio | $119.53 | $38.72 |
| OklahomaOklahoma | $116.75 | $37.71 |
| Portland, OROregon | $140.54 | $42.21 |
| Rest of OregonOregon | $127.70 | $39.54 |
| Metropolitan Philadelphia, PAPennsylvania | $134.20 | $42.06 |
| Rest of PennsylvaniaPennsylvania | $119.91 | $38.65 |
| Puerto RicoPuerto Rico | $130.08 | $40.59 |
| Rhode IslandRhode Island | $132.55 | $41.12 |
| South CarolinaSouth Carolina | $120.30 | $38.52 |
| South DakotaSouth Dakota | $127.15 | $38.64 |
| TennesseeTennessee | $117.84 | $37.38 |
| Austin, TXTexas | $134.94 | $41.29 |
| Beaumont, TXTexas | $119.00 | $38.45 |
| Brazoria, TXTexas | $127.51 | $39.79 |
| Dallas, TXTexas | $128.28 | $40.12 |
| Fort Worth, TXTexas | $127.23 | $39.96 |
| Galveston, TXTexas | $127.85 | $39.96 |
| Houston, TXTexas | $129.32 | $41.43 |
| Rest of TexasTexas | $123.15 | $39.15 |
| UtahUtah | $122.16 | $38.96 |
| VirginiaVirginia | $126.30 | $39.29 |
| Virgin Islands, VIUnited States Virgin Islands | $130.08 | $40.59 |
| VermontVermont | $126.53 | $38.90 |
| Rest of WashingtonWashington | $134.26 | $41.06 |
| King County, WAWashington | $153.91 | $45.30 |
| WisconsinWisconsin | $122.53 | $37.74 |
| West VirginiaWest Virginia | $115.90 | $38.99 |
| WyomingWyoming | $128.23 | $39.72 |
46600 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$112.37
$157.94
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $143.78 | 1 |
| AL | $114.24 | 1 |
| AR | $112.37 | 1 |
| AZ | $125.19 | 1 |
| CA | $138.38–$177.50 | 29 |
| CO | $135.48 | 1 |
| CT | $138.18 | 1 |
| DC | $149.47 | 1 |
| DE | $127.45 | 1 |
| FL | $125.51–$137.45 | 3 |
| GA | $117.75–$131.25 | 2 |
| GU | $142.63 | 1 |
| HI | $142.63 | 1 |
| IA | $118.12 | 1 |
| ID | $118.86 | 1 |
| IL | $121.02–$134.04 | 4 |
| IN | $119.65 | 1 |
| KS | $117.21 | 1 |
| KY | $116.69 | 1 |
| LA | $116.37–$122.91 | 2 |
| MA | $134.41–$150.37 | 2 |
| MD | $130.19–$149.47 | 3 |
| ME | $119.26–$126.97 | 2 |
| MI | $119.86–$126.97 | 2 |
| MN | $130.18 | 1 |
| MO | $113.92–$123.74 | 3 |
| MS | $113.19 | 1 |
| MT | $128.92 | 1 |
| NC | $120.71 | 1 |
| ND | $127.34 | 1 |
| NE | $118.93 | 1 |
| NH | $133.03 | 1 |
| NJ | $139.86–$147.56 | 2 |
| NM | $120.48 | 1 |
| NV | $128.59 | 1 |
| NY | $122.72–$152.83 | 5 |
| OH | $119.53 | 1 |
| OK | $116.75 | 1 |
| OR | $127.70–$140.54 | 2 |
| PA | $119.91–$134.20 | 2 |
| PR | $130.08 | 1 |
| RI | $132.55 | 1 |
| SC | $120.30 | 1 |
| SD | $127.15 | 1 |
| TN | $117.84 | 1 |
| TX | $119.00–$134.94 | 8 |
| UT | $122.16 | 1 |
| VA | $126.30–$149.47 | 2 |
| VI | $130.08 | 1 |
| VT | $126.53 | 1 |
| WA | $134.26–$153.91 | 2 |
| WI | $122.53 | 1 |
| WV | $115.90 | 1 |
| WY | $128.23 | 1 |
How the 46600 rate is calculated
Each of 46600’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 46600
RVUs × geographic indexes × conversion factor
Work0.54
0.54 RVUs× 1.000 GPCI
Practice expense3.24
3.24 RVUs× 1.000 GPCI
Malpractice0.08
0.08 RVUs× 1.000 GPCI
Adjusted RVUs
3.8600
Conversion factor
$33.4009
Medicare rate
$128.93
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Madera, CA inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,598
- Code
- 46600
- Physician work
- 0.54
- Practice expense
- 3.24
- Malpractice
- 0.08
GPCI2026.csv
14
- Locality
- Madera, CA
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.54 | × 1.017 | 0.5492 |
| Practice expense | 3.24 | × 1.096 | 3.5510 |
| Malpractice | 0.08 | × 0.536 | 0.0429 |
| Total RVUs | 4.1431 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Madera, CA$138.38
Office: (0.54 × 1.017 + 3.24 × 1.096 + 0.08 × 0.536) × $33.4009 = $138.38
Facility: (0.54 × 1.017 + 0.59 × 1.096 + 0.08 × 0.536) × $33.4009 = $41.37
Payment rules and modifiers for 46600
The CMS indicators that decide how 46600 is paid alongside other services.
CMS payment indicators · 46600
Diagnostic anoscopy, standard visualization, optional washing
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
46600 without 51 · national office
$128.93
Diagnostic anoscopy, standard visualization, optional washing
46600-51 · Second procedure: 50%
$64.47
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
How 46600 has changed in Madera, CA
46600 · Office / nonfacility
$138.38
Effective 2026-10-01
The base rate is $19.90 higher than on 2025-10-01, moving from $118.48 to $138.38 (16.8%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$118.48changed to$138.38
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 0.55 changed to 0.54
- Practice expense RVU 2.80 changed to 3.24
- Work GPCI 1.014 changed to 1.017
- Practice expense GPCI 1.093 changed to 1.096
- Malpractice GPCI 0.560 changed to 0.536
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$125.75changed to$118.48
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 2.90 changed to 2.80
- Malpractice RVU 0.09 changed to 0.08
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$123.70changed to$125.75
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$128.86changed to$123.70
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 2.95 changed to 2.90
- Malpractice RVU 0.10 changed to 0.09
- Work GPCI 1.021 changed to 1.014
- Practice expense GPCI 1.079 changed to 1.093
- Malpractice GPCI 0.579 changed to 0.560
January 1, 2023
RVU23A
$132.71changed to$128.86
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 3.02 changed to 2.95
- Malpractice RVU 0.09 changed to 0.10
- Work GPCI 1.027 changed to 1.021
- Practice expense GPCI 1.065 changed to 1.079
- Malpractice GPCI 0.597 changed to 0.579
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$130.47changed to$132.71
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 2.93 changed to 3.02
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$111.03changed to$130.47
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 2.30 changed to 2.93
- Work GPCI 1.024 changed to 1.027
- Practice expense GPCI 1.070 changed to 1.065
- Malpractice GPCI 0.580 changed to 0.597
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$102.55changed to$111.03
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 2.08 changed to 2.30
- Work GPCI 1.020 changed to 1.024
- Practice expense GPCI 1.074 changed to 1.070
- Malpractice GPCI 0.562 changed to 0.580
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$95.86changed to$102.55
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 1.91 changed to 2.08
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$94.98changed to$95.86
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 1.88 changed to 1.91
- Work GPCI 1.024 changed to 1.020
- Practice expense GPCI 1.079 changed to 1.074
- Malpractice GPCI 0.610 changed to 0.562
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
No ratechanged to$94.98
Held through RVU17B, RVU17C, RVU17D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $138.38 | $41.37 | RVU26D |
| 2026-07-01 | $138.38 | $41.37 | RVU26C |
| 2026-04-01 | $138.38 | $41.37 | RVU26B |
| 2026-01-01 | $138.38 | $41.37 | RVU26A |
| 2025-10-01 | $118.48 | $41.41 | RVU25D |
| 2025-07-01 | $118.48 | $41.41 | RVU25C |
| 2025-04-01 | $118.48 | $41.41 | RVU25B |
| 2025-01-01 | $118.48 | $41.41 | RVU25A |
| 2024-10-01 | $125.75 | $42.07 | RVU24D |
| 2024-07-01 | $125.75 | $42.07 | RVU24C |
| 2024-04-01 | $125.75 | $42.07 | RVU24B |
| 2024-03-09 | $125.75 | $42.07 | RVU24AR |
| 2024-01-01 | $123.70 | $41.39 | RVU24A |
| 2023-10-01 | $128.86 | $42.20 | RVU23D |
| 2023-07-01 | $128.86 | $42.20 | RVU23C |
| 2023-04-01 | $128.86 | $42.20 | RVU23B |
| 2023-01-01 | $128.86 | $42.20 | RVU23A |
| 2022-10-01 | $132.71 | $42.05 | RVU22D |
| 2022-07-01 | $132.71 | $42.05 | RVU22C |
| 2022-04-01 | $132.71 | $42.05 | RVU22B |
| 2022-01-01 | $132.71 | $42.05 | RVU22A |
| 2021-10-01 | $130.47 | $41.65 | RVU21D |
| 2021-07-01 | $130.47 | $41.65 | RVU21C |
| 2021-04-01 | $130.47 | $41.65 | RVU21B |
| 2021-01-01 | $130.47 | $41.65 | RVU21A |
| 2020-10-01 | $111.03 | $42.68 | RVU20D |
| 2020-07-01 | $111.03 | $42.68 | RVU20C |
| 2020-04-01 | $111.03 | $42.68 | RVU20B |
| 2020-01-01 | $111.03 | $42.68 | RVU20A |
| 2019-10-01 | $102.55 | $42.94 | RVU19D |
| 2019-07-01 | $102.55 | $42.94 | RVU19C |
| 2019-04-01 | $102.55 | $42.94 | RVU19B |
| 2019-01-01 | $102.55 | $42.94 | RVU19A |
| 2018-10-01 | $95.86 | $43.28 | RVU18D |
| 2018-07-01 | $95.86 | $43.28 | RVU18C |
| 2018-04-01 | $95.86 | $43.28 | RVU18B |
| 2018-01-01 | $95.86 | $43.28 | RVU18AR1 |
| 2017-10-01 | $94.98 | $43.09 | RVU17D |
| 2017-07-01 | $94.98 | $43.09 | RVU17C |
| 2017-04-01 | $94.98 | $43.09 | RVU17B |
| 2017-01-01 | $94.98 | $43.09 | RVU17A |
| 2016-10-01 | Rate data unavailable | Rate data unavailable | RVU16D |
| 2016-07-01 | Rate data unavailable | Rate data unavailable | RVU16C |
| 2016-04-01 | Rate data unavailable | Rate data unavailable | RVU16B |
| 2016-01-01 | Rate data unavailable | Rate data unavailable | RVU16A |
| 2015-10-01 | Rate data unavailable | Rate data unavailable | RVU15D |
| 2015-07-01 | Rate data unavailable | Rate data unavailable | RVU15C |
| 2015-04-01 | Rate data unavailable | Rate data unavailable | RVU15B |
| 2015-01-01 | Rate data unavailable | Rate data unavailable | RVU15A |
| 2014-10-01 | Rate data unavailable | Rate data unavailable | RVU14D |
| 2014-07-01 | Rate data unavailable | Rate data unavailable | RVU14C |
| 2014-04-01 | Rate data unavailable | Rate data unavailable | RVU14B |
| 2014-01-01 | Rate data unavailable | Rate data unavailable | RVU14A |
| 2013-10-01 | Rate data unavailable | Rate data unavailable | RVU13D |
| 2013-07-01 | Rate data unavailable | Rate data unavailable | RVU13C |
| 2013-04-01 | Rate data unavailable | Rate data unavailable | RVU13B |
| 2013-01-01 | Rate data unavailable | Rate data unavailable | RVU13AR |
Where the Madera, CA rate applies
Madera, CA is a Medicare payment area, not a city. Our Census mapping connects it to 17 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.
- Madera
- Ahwahnee
- Bass Lake
- Bonadelle Ranchos
- Chowchilla
- Coarsegold
- Fairmead
- La Vina
46600 billing questions
When should 46600 be used instead of 46601?
Use 46600 for standard diagnostic anoscopy. Use 46601 when the examination uses high-resolution magnification.
Can brushing or washing be reported separately?
No. Specimen collection by brushing or washing is included in the diagnostic anoscopy service.
Which code applies if the clinician takes a biopsy?
Use 46606 for anoscopy with biopsy without high-resolution magnification, or 46607 when high-resolution magnification and biopsy are performed.
Does 46600 have a postoperative global period?
It has a 0-day global period. Same-day preoperative and postoperative care is included.
How does the multiple-procedure rule affect 46600?
For procedures performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction.
Can 46600 be billed with bilateral or surgical-team modifiers?
Bilateral adjustment is inappropriate for this code. Assistant-at-surgery payment is restricted, and co-surgeon and team-surgery payment are not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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